The Use of Antifibrinolytic Agents in Spine Surgery

Abstract

Aprotinin, tranexamic acid, and epsilon-aminocaproic acid are effective for reducing blood loss and transfusions in patients managed with spine surgery. With the exception of aprotinin, the side-effect profiles of these agents have not been shown to cause any substantial morbidity or to increase the rate of thromboembolic events. Epsilon-aminocaproic acid had a greater effect on reducing blood transfusions as the complexity of surgery increased. The surgeon and/or the anesthesiologist should consider the use of antifibrinolytic agents for patients undergoing spinal procedures in which a large amount of blood loss can be expected; however, at the present time, this is not a United States Food and Drug Administration-approved indication for these agents.

Intraoperative tranexamic acid use in major spine surgery in adults: a multicentre, randomized, placebo-controlled trial

“…[9][10][11][12][13][14][15] Subsequently, various prospective clinical trials analysed the performance of TXA in adolescents [16][17][18] and adults [19][20][21][22][23][24] undergoing several types of surgery of varying complexity, with divergent results. The 15 first meta-analysis on TXA use in spine surgery, published in 2008, 25 did not offer a clearly favourable recommendation because of the poor methodological quality of the studies included. The drug was being used in off-label conditions because spine surgery was not one of the labelled indications 20 listed in the product insert.…”

“…Transfusion requirements and blood loss 25 Intraoperative haemoglobin (Hb) concentration was monitored in each patient at a frequency depending on the individual blood loss and always before administration of each unit of blood or blood products. According to the established protocol, the Hb transfusion trigger used to indicate administration of packed 30 RBCs was 8 g dL…”

Peri- und intraoperative Gerinnungsstörungen und ihre Therapieempfehlungen

“…Die Verwendung von Antifibrinolytika/Tranexamsäure hat sich bei orthopädischen Patienten als vorteilhaft herausgestellt - sowohl bei systemischer als auch bei topischer Verwendung [88,89,90,91,92,93,94,95,96]; ihre Anwendung wird daher empfohlen [97,98,99]. Wenn eine übermäßige Blutung nicht mit dem (prophylaktischen) Einsatz von Antifibrinolytika (verhindert oder) kontrolliert werden kann, sollten zunächst wieder die bereits oben erwähnten Argumente zur Dilutionskoagulopathie beachtet werden [11,12,13,14], um ausreichend hohe Gerinnungsfaktorkonzentrationen während und nach orthopädischen Operationen sicherzustellen.…”

Prolonged Bleeding After Surgery

“…These conditions are seen with bleeding after pregnancy complications and prostate surgery. Importantly, prophylaxis with antifi brinolytic agents has been demonstrated to reduce bleeding after knee or hip replacement (Alshryda et al 2011 ; (Zufferey et al 2010 ), spine surgery (Gill et al 2008 ), and cardiac surgery (Henry et al 2009 ). The dose of these agents has varied widely between trials.…”